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Anterior Cruciate Ligament (A.C.L.) Injury

I. Description

II. Causes

III. Symptoms

IV. Diagnosis

V. Treatment


Description

The Anterior Cruciate Ligament (ACL) is one of the four major ligaments of the human knee. Ligaments are a connective tissue, connecting bone to bone across joints. The ACL serves to connect the knee joint, stabilize movement, and limit rotational movement. The lower leg bone (tibia) and thigh bone (femur) have a special padding between them called the menisci that serves to absorb shock and cushion the movements between the bones. The ACL helps to keep the two bones in their erect, vertical alignment. The ACL minimizes excessive forward movement of the lower leg bone (the tibia) in relation to the thigh bone (the femur). Sudden stops or sideways movements (common in certain sports like soccer and football) can cause the ACL to rip partially or completely. A complete tear is often accompanies by a "pop" sound and sensation within the knee. ACL injuries are among the top five most common sports-related injuries and can also be one of the more severe injuries depending on the completeness of the tear, requiring reconstructive surgery to repair the torn ligaments. ACL injuries are graded according to a severity scale:
  • Grade I ACL Sprains- the ACL has only been stretched and there is no tear
  • Grade II sprains involve a slight tear
  • Grade III sprains involve a complete tear


Causes

A tear to the ACL results from overstretching of the ligament, either to the point of a partial or complete tear. Because the main function of the ACL is to manage the rotational movement within the knee, the ACL can be torn when movement is suddenly stopped, causing the knee joint to twist. Commonly the ACL is injured in “quick stop” sports such as basketball, tennis, soccer and football. Sudden force or a blow to the front of the knee can also result in a tear.

Symptoms

Grade I ACL injury symptoms:
  • Mild pain, tenderness and swelling
  • Walking is possible with little difficulty with a Grade I ACL injury
Grade II ACL injury symptoms:
  • Mild to moderate pain around the knee
  • Mild to moderate swelling around the knee
  • The knee feels unstable at times and may “give out” unexpectedly, making walking more difficult
Grade III ACL injury symptoms:
  • A "pop" sound or sensation may occur at the time of injury
  • Pain and swelling of varying degrees from mild to intense
  • A complete tear has occurred and medical attention is required. The knee feels unstable or gives out intermittently, and walking is difficult or impossible. Resting the knee with crutch use is mandatory until a medical exam is possible, and then follow weight bearing/crutch use instructions by your physician.

Diagnosis

Diagnosing and Anterior Cruciate Ligament Injury (A.C.L.) can involve:
  • A physical exam and thorough history by a physician to assess the injury
  • X-rays or MRIs to assess the extent of the tear
  • KT 1000: a device that can measure the amount of forward motion of the lower leg in relation to the upper leg. The movements of the two legs are compared, and the integrity of the ACL can be determined.
  • Your physician may perform ligament stability tests such as the Lachmans test. The knee is bent to thirty degrees while the tibia is gently pulled to check the forward motion of the lower leg in relation to the upper leg. Increased forward motion without a firm stop at the end of the movement can indicate a torn ACL, as it can no longer restrain the forward movement.


Treatment

Treatment for ACL injuries vary by the grade and severity of the injury and typically involves a combination of professional and at-home care. Immediately after injuring the Anterior Cruciate Ligament, protecting the damaged ACL with an appropriate brace is vital to help relieve knee pain, provide needed support and protect against further damage between the injury, the doctor’s evaluation, the MRI and the surgery.

At-Home Care for Grade I Anterior Cruciate Ligament (A.C.L.) Sprain:

  • Grade I ACL Sprain Braces- Light compression braces worn for daily activities assist with pain and swelling, and can often encourage a faster recovery time while protecting the injured tissues. They also help relieve knee pain and reduce knee swelling by helping prevent fluid build-up.
  • Knee Ice Packs- Ice the knee for 10-15 minutes two to three times a day (depending on the degree of swelling and tenderness) until the swelling and pain have dissipated. Icing helps reduce inflammation and also helps “numb” the area, limiting the amount of pain the brain feels due to the amount of sensory cold signals.
  • Balance and Exercise- Balance boards and gentle exercise can help strengthen and rebuild weakened muscles and tissues that support your sprained Anterior Cruciate Ligament (A.C.L.). Start slowly and allow time to gradually regain full use of your knee; the stretched ligament in a Grade I Anterior Cruciate Ligament sprain will need time to heal and repair, but exercise can help the knee to heal with proper function and movement.
  • Pain Gels- These topical analgesics can help provide temporary relief and get you through a painful knee episode.
  • Magnets- Magnetic therapy has been known to help promote healing by increasing blood circulation. The increased blood flow to injured areas helps bring the healing properties of the blood into damaged tissues, and may help reduce pain. 
  • Rest the knee as much as possible for 1-2 weeks and avoid strenuous sporting events or training activities. Use crutches if necessary to avoid placing excessive weight on the injured knee.
  • Elevate the knee- Elevate the foot above heart level for 15-30 minutes two to three times per day or as the swelling level demands. Standing tends to cause inflammation and swelling to drain towards the feet, and if you have an injured knee, the swelling can increase when you are sitting, standing and walking. Situating the feet above the level of the heart helps the excess fluid drain away from the injured area which helps to relieve pain. 

At-Home Care for Grade II Anterior Cruciate Ligament (A.C.L.) Sprain:

  • Grade II ACL Daily Wear Knee Braces- Moderate compression braces worn for daily activities assist with pain and swelling, and can often encourage a faster recovery time while protecting the injured tissues. They also help relieve knee pain and reduce knee swelling by helping prevent fluid build-up. 
  • Grade II ACL Sports Protection Braces- These braces are designed to wear during athletic activities while your A.C.L. is still injured. They can help guard against further damage and still allow for some movement during active sessions.
  • Knee Ice Packs- Ice the knee for 10-15 minutes two to three times a day (depending on the degree of swelling and tenderness) until the swelling and pain have dissipated. Icing helps reduce inflammation and also helps “numb” the area, limiting the amount of pain the brain feels due to the amount of sensory cold signals. 
  • Knee Heat Therapy- After the acute injury stage has passed and swelling is gone, heat can be a great way to soothe sore tissues and bring deep, targeted relief to the area.
  • Balance and Exercise- Part of your recovery may include therapeutic exercises to rehabilitate the knee. Always get clearance from your physician before beginning an exercise routine. Balance boards and gentle exercise can help strengthen and rebuild weakened muscles and tissues that support your sprained Anterior Cruciate Ligament (A.C.L.).
  • Pain Gels- These topical analgesics can help provide temporary relief and get you through a painful knee episode.
  • Rest the knee as much as possible for 1-2 weeks and avoid strenuous sporting events or training activities. Use crutches if necessary to avoid placing excessive weight on the injured knee.
  • Elevate the knee- Elevate the foot above heart level for 15-30 minutes two to three times per day or as the swelling level demands. Standing tends to cause inflammation and swelling to drain towards the feet, and if you have an injured knee, the swelling can increase when you are sitting, standing and walking. Situating the feet above the level of the heart helps the excess fluid drain away from the injured area which helps to relieve pain. 

Grade III Anterior Cruciate Ligament (A.C.L.) Sprain Treatment

Professional care is required for Grade III Anterior Cruciate Ligament sprains, involving reconstructive surgery to repair the torn ligament. It is usually done by arthroscopy and involves using tendon tissue from other parts of the body (like the patellar tendon). Physical therapy may be prescribed by your physician to help rebuild the muscles and ligaments after surgery, as well as to maintain functional movement and proper alignment of the knee as it heals. Pain medications such as NSAIDS (Non-Steroidal Anti Inflammatory Drugs) like ibuprofen and prescription medications can be used to help manage post-operative pain and keep inflammation down. Keeping the knee rested and elevated periodically will also help to reduce swelling and allow the tissues time to repair.

Though a Grade III Anterior Cruciate Ligament (A.C.L.) sprain will need to be managed professionally, here are some helpful home hints:
  • Post-Operative Braces- Whether you have a knee scope or an ACL graft, it is important to stabilize the knee after surgery and if necessary to limit the amount of knee movement during the delicate recovery stages to allow proper healing.
  • Knee Immobilizers- Your physician may suggest a knee immobilizer after surgery to guard against unwanted movement during the initial recovery stage.
  • Hinged Knee Braces- Provide adjustable control over knee range of motion, and can be useful for daily wear after the initial post-operative stages.
  • Continuous Cooling Therapy- Many have found ice water coolers to be most effective. The coolers continuously circulate cold water to the injured area. Ice coolers can be used throughout the day but should not be used for more than twenty minutes per hour (unless otherwise instructed by your doctor).
  • Knee Ice Packs- Ice the knee for 10-15 minutes two to three times a day (depending on the degree of swelling and tenderness) until the swelling and pain have dissipated. Icing helps reduce inflammation and also helps “numb” the area, limiting the amount of pain the brain feels due to the amount of sensory cold signals (follow your physician's instructions for icing the knee post-surgery).
  • Knee Heat Therapy- After the acute injury stage has passed and swelling is gone, heat can be a great way to soothe sore tissues and bring deep, targeted relief to the area.
  • Crutches- Crutches may be necessary to assist with mobility and keeping weight off the knee. Follow your physician's instructions with crutch use.
  • Balance and Exercise- Post healing exercise can help gradually rebuild your knee strength and can be a part of your recovery once you have been cleared by a physician to begin exercise.

Post Healing- After you have had an ACL injury or surgery, remember to protect your knee and avoid heavy work loads. Use caution while participating in sporting events. It’s just not fun to go through it a second time!

 


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